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Therapy for alcoholic liver disease.
World J Gastroenterol. 2014 Mar 07; 20(9):2143-58.WJ

Abstract

Alcoholism results in about 2.5 million deaths annually worldwide, representing 4% of all mortality. Although alcoholism is associated with more than 60 diseases, most mortality from alcoholism results from alcoholic liver disease (ALD). ALD includes alcoholic steatosis, alcoholic hepatitis, and alcoholic cirrhosis, in order of increasing severity. Important scoring systems of ALD severity include: Child-Pugh, a semi-quantitative scoring system useful to roughly characterize clinical severity; model for end-stage liver disease, a quantitative, objective scoring system used for prognostication and prioritization for liver transplantation; and discriminant function, used to determine whether to administer corticosteroids for alcoholic hepatitis. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including twelve-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Disulfiram decreases alcohol consumption by causing unpleasant sensations after drinking alcohol from accumulation of acetaldehyde in serum, but disulfiram can be hepatotoxic. Adjunctive pharmacotherapies to reduce alcohol consumption include naltrexone, acamprosate, and baclofen. Nutritional therapy helps reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. Although reduced protein intake was previously recommended for advanced ALD to prevent hepatic encephalopathy, a diet containing 1.2-1.5 g of protein/kg per day is currently recommended to prevent muscle wasting. Corticosteroids are first-line therapy for severe alcoholic hepatitis (discriminant function ≥ 32), but proof of their efficacy in decreasing mortality remains elusive. Pentoxifylline is an alternative therapy. Complications of advanced ALD include ascites, spontaneous bacterial peritonitis, esophageal variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and portopulmonary hypertension. Alcoholic cirrhotics have increased risk of developing hepatomas. Liver transplantation is the ultimate therapy for severe ALD, but generally requires 6 mo of proven abstinence for eligibility. Alcoholic cirrhotics who maintain abstinence generally have a relatively favorable prognosis after liver transplantation.

Authors+Show Affiliations

Maryconi M Jaurigue, Mitchell S Cappell, Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, United States.Maryconi M Jaurigue, Mitchell S Cappell, Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, United States.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

24605013

Citation

Jaurigue, Maryconi M., and Mitchell S. Cappell. "Therapy for Alcoholic Liver Disease." World Journal of Gastroenterology, vol. 20, no. 9, 2014, pp. 2143-58.
Jaurigue MM, Cappell MS. Therapy for alcoholic liver disease. World J Gastroenterol. 2014;20(9):2143-58.
Jaurigue, M. M., & Cappell, M. S. (2014). Therapy for alcoholic liver disease. World Journal of Gastroenterology, 20(9), 2143-58. https://doi.org/10.3748/wjg.v20.i9.2143
Jaurigue MM, Cappell MS. Therapy for Alcoholic Liver Disease. World J Gastroenterol. 2014 Mar 7;20(9):2143-58. PubMed PMID: 24605013.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapy for alcoholic liver disease. AU - Jaurigue,Maryconi M, AU - Cappell,Mitchell S, PY - 2013/11/22/received PY - 2014/01/07/revised PY - 2014/01/20/accepted PY - 2014/3/8/entrez PY - 2014/3/8/pubmed PY - 2015/4/7/medline KW - Alcoholic cirrhosis KW - Alcoholic hepatitis KW - Alcoholic liver disease KW - Alcoholic steatosis KW - Alcoholism KW - Corticosteroids KW - Liver disease KW - Liver transplantation KW - Pentoxifylline SP - 2143 EP - 58 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 20 IS - 9 N2 - Alcoholism results in about 2.5 million deaths annually worldwide, representing 4% of all mortality. Although alcoholism is associated with more than 60 diseases, most mortality from alcoholism results from alcoholic liver disease (ALD). ALD includes alcoholic steatosis, alcoholic hepatitis, and alcoholic cirrhosis, in order of increasing severity. Important scoring systems of ALD severity include: Child-Pugh, a semi-quantitative scoring system useful to roughly characterize clinical severity; model for end-stage liver disease, a quantitative, objective scoring system used for prognostication and prioritization for liver transplantation; and discriminant function, used to determine whether to administer corticosteroids for alcoholic hepatitis. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including twelve-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Disulfiram decreases alcohol consumption by causing unpleasant sensations after drinking alcohol from accumulation of acetaldehyde in serum, but disulfiram can be hepatotoxic. Adjunctive pharmacotherapies to reduce alcohol consumption include naltrexone, acamprosate, and baclofen. Nutritional therapy helps reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. Although reduced protein intake was previously recommended for advanced ALD to prevent hepatic encephalopathy, a diet containing 1.2-1.5 g of protein/kg per day is currently recommended to prevent muscle wasting. Corticosteroids are first-line therapy for severe alcoholic hepatitis (discriminant function ≥ 32), but proof of their efficacy in decreasing mortality remains elusive. Pentoxifylline is an alternative therapy. Complications of advanced ALD include ascites, spontaneous bacterial peritonitis, esophageal variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and portopulmonary hypertension. Alcoholic cirrhotics have increased risk of developing hepatomas. Liver transplantation is the ultimate therapy for severe ALD, but generally requires 6 mo of proven abstinence for eligibility. Alcoholic cirrhotics who maintain abstinence generally have a relatively favorable prognosis after liver transplantation. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/24605013/Therapy_for_alcoholic_liver_disease_ L2 - http://www.wjgnet.com/1007-9327/full/v20/i9/2143.htm DB - PRIME DP - Unbound Medicine ER -